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Fistula on the tooth

definition

In medicine, a fistula represents a non-physiological connection between two body cavities or between an internal organ and the body surface.
This connection is called an internal or external fistula. It is used to drain a liquid. A fistula on the tooth belongs to the second category, it usually connects a pus-filled cavity with the oral cavity through a so-called fistula duct. The pus cavity, a so-called abscess that has arisen from chronic inflammation at the tip of a tooth, can then empty through the duct.

causes

Inadequate oral hygiene leads to tooth decay. Caries cause bacteria from the oral cavity to enter the tooth cavity and thus migrate to the tip of the root. Bacteria can easily multiply there and form a source of inflammation, especially in the case of a weakened immune system. This inflammation can spread inside and attack the bone over a longer period of time.
The body sends more and more so-called inflammatory cells to the damaged area, creating pus. This pus can no longer drain naturally. He finds his own way out through the jawbone. This creates a fistulous duct.
A tooth fracture, orthodontic treatment or periodontal disease can also trigger such a process. According to recent studies, smoking is an inflammation-promoting factor and therefore an increased risk.

Fistula on the tooth after root canal treatment

A tooth fistula cannot heal after a root canal treatment. The reason for this lies in the persistence of the previous inflammation because there are still bacteria in the damaged area. The inflammation may return. Sometimes the fistula even arises afterwards.
A perforation (puncture) of the tooth root by the dentist during root canal treatment can be the cause. The dentist pierces the tooth root towards the bone with his instruments, sometimes unconsciously (often strongly curved root canals are a particular difficulty), so that a hole is created there. Inflammation can develop at this opening again, which can be accompanied by the formation of pus and fistula.

Also read our topic: Antibiotics after a root canal treatment

Fistula on the tooth after apicectomy

If an apicectomy has been performed, symptoms can sometimes persist and a fistula can form.
This is always based on the problem that the previous treatment could not achieve sufficient freedom from germs. Incorrect preparation of the root, failure of a root canal, use of unsuitable irrigation fluid or a leaking tooth seal can be the cause. The apicectomy can only be as good as the root filling on which it is based. It may have to be renewed if the pain persists in order to be successful.

Read more on the subject at: Inflammation after apicectomy

diagnosis

The dentist can diagnose a “tooth fistula” at first glance based on the typical-looking reddish-yellow protrusion of the gums.
However, further examinations follow the optical examination to pinpoint the tooth that is causing the fistula. A percussion test and a sensitivity test are carried out. That is, the teeth are first tapped with a dental instrument and then a cold foam pellet is held against the teeth. The dentist wants to determine the reaction of the teeth to pressure and cold. An X-ray is taken to show the exact location and extent of the damage.
This information can then be used to initiate appropriate treatment steps.

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Symptoms

In the early stages, the fistula causes little to no discomfort. Most of the time it feels like a slight inflammation that you rarely even notice.
Over the course of a few weeks, a slight stinging or knocking may be heard, which can be accompanied by a feeling of tension. Initially, a swelling forms around the diseased tooth, which turns into a pus blister. Severe pain can also occur at this point. As soon as the pressure in the bladder reaches its peak, the fistula empties into the oral cavity. The pain will then decrease for a short time while the bladder can refill.
Even with no symptoms, the pathological process continues within the bone. The inflammation progresses and the bone is damaged until the cause of the inflammation is found and corrected.

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Treatment of the fistula

The aim of the treatment of the dental fistula is a maximum reduction of bacteria and the complete healing of the defect. This is the only way to achieve lasting freedom from symptoms.
After the diagnosis has been made, the tooth is trephined, i.e. opened. For this, a hole is drilled with a drill up to the tooth cavity and the purulent secretion is sucked off there. This drainage reduces the pressure on the tooth, and the pain is partially alleviated.
A subsequent x-ray then decides whether the teeth will be preserved. If the damage has progressed too much, the tooth must be extracted. If the tooth can still be saved, the dentist will perform a root canal treatment and remove the root tissue damaged by the bacteria. This should make the pain go away completely. If this is not the case, a root tip resection can also be carried out to rehabilitate the damaged area. An oral antibiotic is often also prescribed to eliminate the bacteria completely and to speed up the healing process.

When do you need an antibiotic?

In most cases of a fistula, antibiotics are indicated. The cause of the development of fistulas is persistent inflammation. This inflammation destroys the surrounding tissue and forms a kind of duct, a so-called fistula duct, towards a surface. This can e.g. the mouth or the cheek.

Antibiotics must be used to combat this. Often pus forms that is drained through the fistula. If the cyst is already very large and has to be surgically opened and emptied, antibiotics are also prescribed after the operation to speed up healing and prevent re-inflammation. As a result, an antibiotic is necessary for almost every fistula.

Read more on the topic: That's how dangerous a fistula in the mouth is

Which antibiotic works best?

In the case of infections in the tooth and jaw area, broad-spectrum penicillins, i.e. penicillins that fight a broad spectrum of pathogens, or clindamycin is the antibiotic of choice for a penicillin allergy in many cases.
Both antibiotics attack at different points in the metabolism of the bacteria. When the fistula is surgically opened, a smear can be taken and an antibiotic that is especially effective against the pathogens present can be taken.

How can I treat the fistula myself?

It is generally not recommended to treat the tooth fistula yourself. It may happen that the fistula heals on its own, but the tooth inflammation inside the body does not. Even if the fistula has healed, the tooth still needs treatment to prevent it from coming back.
A dental fistula should only be opened and treated by the dentist, as only the dentist has the necessary specialist knowledge of the cause. Furthermore, the same sterility as in practice is not required under domestic circumstances. The use of non-sterile objects to treat fistulas could further promote and promote the inflammatory reaction.
Pain relief alone can push the disease into the subconscious. One would forget the problem and the inflammation could spread to the abscess. An abscess in the head and neck area is extremely dangerous because under unfavorable conditions it can even reach the brain and cause permanent damage.

Can I prick a fistula myself?

A fistula is an unnatural and, in this case, pathological connection between the tooth root and the oral cavity. This has formed due to an inflammation at the tooth root. The pus from the inflammation eventually drains into the oral cavity through a kind of tube acting as a drainage channel. From the moment it is emptied, the fistula in the mouth is usually no longer painful. It is recommended to see a dentist who will professionally remove the inflammation.

The need for an operation depends on the location and size of the fist. However, it is often necessary to operate. The dentist removes the causative purulent inflammation (usually a root inflammation) and disinfects the wound. It is not recommended to prick the fistula on your own. In most cases, even more bacteria can enter the wound than is already the case. Another risk is that the pus, and with it the bacteria, will spill into the surrounding tissue when pricked and thus cause extensive inflammation.

homeopathy

There are many homeopathic remedies. Among other things, the means Silicea C4 and Hekla Lava C5, which can be used depending on the severity of an inflammation.
In the case of fistulas and bone necrosis, they are supposed to improve the body's ability to regenerate. The self-healing rate should be increased by accelerating the inflammatory reaction. That way, the inflammation would heal quickly and easily.
However, the following principle applies: without mechanical opening of the tooth, no healing of the dental fistula can be expected in the long term!

Home remedies

There are no home remedies that can address the cause of a tooth fistula.
Chamomile, given in tea or in gel form, can have soothing effects through its anti-inflammatory and antibacterial effects. It is similar with onions, garlic and clove oil, all of which can be applied to the fistula in the hope of relief. Even though symptoms improve initially, the cause of the inflammation remains unaffected by these home remedies. The bacteria can spread further and cause more damage. Hence, no cure can occur.
This is of particular concern during pregnancy. Home remedies should never be used there. Prolonged inflammation could be harmful to the unborn child. A visit to the dentist should not be avoided!

How dangerous can a fistula on a tooth be?

A fistula can be very painful, especially at the beginning of its development. However, as soon as an opening has formed, e.g. to the oral cavity, the pain disappears. A small pustule on the lining of the mouth represents the opening of the fistula, through which pus drains. The disappearing pain is what is dangerous about a fistula. Those affected do not notice the fistula at an advanced stage because it does not cause any symptoms.

However, the inflammation progresses in depth and continues to spread unhindered. Destruction of bones and other surrounding tissues occurs. Furthermore, this can lead to tooth loss. In the worst case, the inflammation can spread to the bone marrow and thus to the bloodstream.

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Duration

The duration of a fistula on the tooth is difficult to assess. Some people have severe pain even if they are not so severe and go to the doctor straight away, but still others don't notice anything and only go to the doctor after months.
As a rule, after an inflammation of the root tip, it only takes a short time before an uncomfortable feeling can be felt on the tooth. The fistula then develops over the course of several weeks, with the pain increasing over time. Rapid pain relief is felt once treatment is started. When a root canal treatment has been completed and the tooth is painless, the opened tooth can be permanently closed again.
The damage to the bone around the guilty tooth only heals within a few months if there is no bacteria. This is related to the slower healing rate of bones in general.

Fistula on the tooth in the child

Tooth fistulas can occur in children for the same reasons as in adults. Treatment differs, however.
The inflammation is also chronic and usually not painful.
If it is based on a milk tooth, this must be removed. Root canal treatment could damage the underlying tooth germ of the permanent teeth and is therefore not indicated. However, since preservation of the tooth would not be possible with other methods, there is no other option than extraction.
However, if the focus of inflammation is a permanent tooth in the child or if there are no permanent tooth germs due to a congenital malformation, then a root canal treatment can also be considered for a child. The attending physician must decide this in the individual case.